﻿<div class="col-lg-12 wrapperbox">
	<form class="form-horizontal" role="form" method="POST">	  
			<div class="form-group">
			<label for="" class="col-sm-2 control-label">送货单位</label>
			<div class="col-sm-10">
				<select class="form-control" id="sendunit">
					<option>西南食品城</option>
					<option>毛记冒菜</option>
					<option>麻辣串串</option>
					<option>江油肥肠</option>
					<option>美蛙鱼头</option>
				</select>
			</div> 
			</div>
			<div class="form-group">
			<label for="" class="col-sm-2 control-label">采购单位</label>
			<div class="col-sm-10">
				<select class="form-control" id="purchase">
					<option>武侯中学</option>
					<option>玉林中学</option>
					<option>成都七中</option>
					<option>石实中学</option>
					<option>南山中学</option>
				</select>
			</div>
			</div>
		<div class="form-group">
			<label for="" class="col-sm-2 control-label">食材名称</label>
			<div class="col-sm-10">
				<input type="text" class="form-control" id="fdname" placeholder="食材名称">         
			</div>
		</div>
		<div class="form-group">
			<label for="" class="col-sm-2 control-label">供货数量</label>
			<div class="col-sm-10">
				<input type="text" class="form-control" id="sendNum" placeholder="供货数量">         
			</div>
		</div>
		<div class="form-group">
			<label for="" class="col-sm-2 control-label">单价</label>
			<div class="col-sm-10">
				<input type="text" class="form-control" id="sendprice" placeholder="单价">         
			</div>
		</div>
		<!--<div class="form-group">
			<label for="" class="col-sm-2 control-label">金额小计</label>
			<div class="col-sm-10">
				<input type="text" class="form-control" id="allprice" placeholder="金额小计">         
			</div>
		</div>-->
		<div class="form-group">
			<label for="" class="col-sm-2 control-label">签收人</label>
			<div class="col-sm-10">
				<input type="text" class="form-control" id="signname" placeholder="签收人">         
			</div>
		</div>
		<div class="form-group">
			<label for="" class="col-sm-2 control-label">签收状态</label>
			<div class="col-sm-10">
				<input type="text" class="form-control" id="signStatus" placeholder="签收状态">         
			</div>
		</div>
		<div class="form-group">
			<label for="" class="col-sm-2 control-label">签收备注</label>
			<div class="col-sm-10">
				<input type="text" class="form-control" id="signRemarks" placeholder="签收备注">         
			</div>
		</div>
		<div class="form-group">
			<label for="" class="col-sm-2 control-label">结算户名</label>
			<div class="col-sm-10">
				<input type="text" class="form-control" id="settlementName" placeholder="结算户名">         
			</div>
		</div>
		<div class="form-group">
			<label for="" class="col-sm-2 control-label">结算银行</label>
			<div class="col-sm-10">
				<input type="text" class="form-control" id="settlementBank" placeholder="结算银行">         
			</div>
		</div>
		<div class="form-group">
			<label for="" class="col-sm-2 control-label">结算账号</label>
			<div class="col-sm-10">
				<input type="text" class="form-control" id="settlementNum" placeholder="结算账号">         
			</div>
		</div>
		
	</form> 		
</div>